Exoprosthesis - Permanent Prosthesis

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Exoprosthesis - Permanent Prosthesis
Exoprosthesis - Permanent Prosthesis

Video: Exoprosthesis - Permanent Prosthesis

Video: Exoprosthesis - Permanent Prosthesis


After an amputation, interim prostheses ("transitional prostheses") are usually fitted until they have completely healed. After the amputation site has completely healed, prostheses for permanent use - so-called exoprostheses - are adapted.


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  • How is the right exoprosthesis chosen?
  • How are exoprostheses attached?
  • What complications can exoprostheses cause?
  • How does an exoprosthesis change the life of those affected?
  • Whom can I ask?
  • How will the costs be reimbursed?

For permanent prostheses, a distinction is made between passive, active and hybrid prostheses:

Passive exoprostheses

With passive exoprostheses, little or no movements can be performed by engaging and disengaging hinge joints or by transferring movements of healthy joints. The passive exoprostheses include cosmetic prostheses - so-called epitheses (e.g. jewelry arms). This mimics the missing part of the body. They are easy to use and light. Other passive prostheses are working prostheses. With these, various tools can be placed on the shaft. The best-known working prosthesis is "the hook".

Active exoprostheses

Active exoprostheses include external power prostheses and self-powered prostheses.

External force prostheses

In the case of external force prostheses, preset movement sequences are carried out using a control. This can be attached directly to the prosthesis or operated via a remote control or a computer.

Self-strength prostheses

With self-powered prostheses, movements are controlled by muscle activation using so-called myoelectric signals. Myoelectric signals are sent out by activating the muscles. When muscles are tensed and relaxed, electrical current flows through the inflow or outflow of ions (charged particles) into muscle cells. These electrical currents are recognized by sensors in the prosthesis and trigger targeted prosthesis movements.

The most modern self-powered prostheses are "thought-controlled" prostheses. With these prostheses, nerves that control the movements of a body part are detached from the surrounding tissue before it is amputated. They are then attached to a muscle (usually chest muscle) that has previously been separated from its original nerve supply (targeted muscle reinnervation - TMR). When the nerves are transferred to the muscle, individual nerve fibers that transmit certain movement information to the muscle (e.g. bending a certain finger) are fixed at precisely defined points on the muscle. In these areas, sensors are attached that recognize myoelectric signals and transmit appropriate movement commands to the prosthesis. When the prosthesis wearer introduces himself / herself,perform a certain movement, this movement is then carried out by the prosthesis.

Hybrid prostheses

Hybrid prostheses consist of an active and a passive part. With forearm prostheses, for example, movements of the elbow joint can be passively fixed by a certain movement of the upper arm and additionally combined with a myoelectric hand prosthesis.

Note Pressure, pain, vibration and temperature sensors on prostheses that send information to the central nervous system should enable the perception of feelings in the future. This may also relieve phantom pain.

How is the right exoprosthesis chosen?

The choice of a prosthesis is made individually. The focus is on practical use. High-tech prostheses cannot be used equally well by all patients.

The selection of a prosthesis therefore depends on:

  • Type and level of an amputation or the healing process after an amputation,
  • Concomitant injuries (or further amputations) and concomitant diseases,
  • Educational level, social and cultural environment as well as the patient's age,
  • Cost units / cost units.

How are exoprostheses attached?

It is particularly important for the wearer that the prosthesis is comfortable to wear, that it is easy to put on and take off and that it is easy to clean.

Exoprostheses can for example:

  • by sucking in the prosthesis by means of negative pressure (suction prostheses),
  • via screw connections or bandages or
  • by connecting devices made of plastic

attached to the body.

To avoid circulatory disorders, the shaft must not constrict the part of the body to which it is attached. In addition, the material used at the point of contact with the skin must be such that perspiration is avoided as well as possible.

Note Transitional prostheses are adjusted in the hospital after an amputation with stable wound conditions as soon as the affected part of the body can be loaded again. Permanent prostheses can be adjusted outside the hospital.

What complications can exoprostheses cause?

Complications after an amputation:

  • General surgical complications

    • Bleeding
    • Wound infection
    • Wound healing disorders - e.g. contractures (tissue retraction) in the area of the amputation scar
    • thrombosis
  • Phantom pain after amputation
  • Osteomyelitis (inflammation of the bone marrow) and exostoses (bone growths) at the end of the amputation stump

Complications from the prosthesis:

  • Circulatory disorders and pressure points when pressure is applied through the prosthesis
  • Material incompatibility
  • Infections in the part of the body to which the prosthesis is attached (e.g. if you sweat more than normal or if you take irregular care of the affected skin
  • Pain and damage to the musculoskeletal system due to incorrect adjustment or insufficient prosthesis training

How does an exoprosthesis change the life of those affected?

In particular, the control of self-powered prostheses must be repeatedly and intensively practiced. In particular, the “thought-controlled” exoprosthesis requires a lot of motivation to practice individual movements. With sufficient training, however, movements are triggered automatically over time. This means that the wearer no longer has to actively think about a movement in order to perform it.

At first, an exoprosthesis also feels strange. When it is well adapted to the body and new movements are practiced, it is slowly integrated into the body image (embodiment). Everyday life has to be restructured and everyday movements with the prosthesis have to be rehearsed.

Ideally, an exoprosthesis is hardly noticeable after a certain amount of time in everyday life while it is being worn.

Prosthesis and residual limb care (residual limb: part of the body that has been preserved) must be learned well and carried out regularly in order to become part of the normal everyday routine after a certain period of time. After the initial adjustment of an exoprosthesis, regular visits to the orthopedic technician are often necessary for further adjustments to the prosthesis.

Especially with exoprostheses that are clearly visible from the outside, a high degree of self-esteem and self-confidence is required. Frightened or pitying looks or comments from others are often far more unpleasant for many prosthesis wearers than the prosthesis itself. If this is very stressful, psychological or psychotherapeutic care can be relieving and supportive. Joining a self-help group can also be helpful through contact with other people who have similar everyday experiences.

Whom can I ask?

Exoprostheses are made by an orthopedic technician in collaboration with a specialist in orthopedics or traumatology (trauma surgery). Physiotherapists or occupational therapists can also be involved in the planning of the prosthesis production or in the selection of the prosthesis.

If an exoprosthesis is to be adjusted after an accident or illness, the treating physicians usually carry out initial consultations and preliminary examinations during the hospital stay. A transition prosthesis can also be adjusted in the hospital.

How will the costs be reimbursed?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at:

  • Right to treatment
  • Visit to the doctor: costs and deductibles
  • What does the hospital stay cost?
  • Prescription fee: This is how drug costs are covered
  • Rehabilitation & cure
  • Medical aids & aids
  • Health Professions AZ

and via the online guide to reimbursement of social insurance costs.

For certain non-drug treatments (e.g. physical therapy), approval from the health insurance company is required.

Prostheses and walking aids (e.g. crutches) are requested via a medical aid prescription. Depending on the health insurance provider, patient co-payments are provided for in the settlement. Further information can be found under: Aids and remedies.

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